Evidence Based Medicine

[free_spirit_etc]

Has anyone ever used the Evidence Based Medicine opinions. I was looking into that, but was not sure if anyone has experience with the VA with it. It seems like it would be right up the VA's ally - as it doesn't speculate or so much give opinions as it does a "based on the odds" type thing.

I was thinking it might be good for my husband's claim (thus my claim) - as the in-service incurrance would be based on the fact that the 3 cm tumor found 2 years after he retired could not have grown NEARLY that fast -- based on the type of cancer he had. (Medical standards say that it would take about 17 years for pulmonary adenocarcinoma to reach that size). My husband entered the service in 1970 and retired in 1998. Cancer found in 2000.

So I was figuring with all the odds - that an evidence based medicine report would show that the odds of him having the cancer for more than 2 years would certainly be more likely than not.

I might also see if they could provide a report for --IF the VA acknowledges asbestos exposure for the 13 years he was an electrician - the odds of the asbetos exposure playing a role in the subsequent development of the lung cancer would be great.

The only medical "evidence?" they have that the asbestos did not play a role in the development of the cancer is that the C&P doctor who did not see him stated that it was his opinion that my husband wasn't exposed to asbestos because he didn't have any record of occupational medical survillience or any unique medical conditions that would suggest asbestos exposure.

He overlooked his Interstitial Lung Disease, he overlooked that the base medical records said likely exposure to asbestos, and he overlooked that the occupational screenings were not started until my husband was no longer an electrician.

So has anyone at hadit ever used one of the evidence based medicine reports?

Thanks

Free

[betrayed]

Has anyone ever used the Evidence Based Medicine opinions. I was looking into that, but was not sure if anyone has experience with the VA with it. It seems like it would be right up the VA's ally - as it doesn't speculate or so much give opinions as it does a "based on the odds" type thing.

I was thinking it might be good for my husband's claim (thus my claim) - as the in-service incurrance would be based on the fact that the 3 cm tumor found 2 years after he retired could not have grown NEARLY that fast -- based on the type of cancer he had. (Medical standards say that it would take about 17 years for pulmonary adenocarcinoma to reach that size). My husband entered the service in 1970 and retired in 1998. Cancer found in 2000.

So I was figuring with all the odds - that an evidence based medicine report would show that the odds of him having the cancer for more than 2 years would certainly be more likely than not.

I might also see if they could provide a report for --IF the VA acknowledges asbestos exposure for the 13 years he was an electrician - the odds of the asbetos exposure playing a role in the subsequent development of the lung cancer would be great.

The only medical "evidence?" they have that the asbestos did not play a role in the development of the cancer is that the C&P doctor who did not see him stated that it was his opinion that my husband wasn't exposed to asbestos because he didn't have any record of occupational medical survillience or any unique medical conditions that would suggest asbestos exposure.

He overlooked his Interstitial Lung Disease, he overlooked that the base medical records said likely exposure to asbestos, and he overlooked that the occupational screenings were not started until my husband was no longer an electrician.

So has anyone at hadit ever used one of the evidence based medicine reports?

Thanks

Free

what you talking about?

[Berta]

I never heard of this before-evidence based medical reports?

if the C & P doctor based his opinion on faulty readings of your husband's SMRs and occupational data- etc- this is part of the way a good IMO doctor can attack and overcome the medical rationale of the C & P doctor-

[free_spirit_etc]

There are a few companies offering these. I would think that IF the evidence would be IN your favor (as more likely than not) -- especially if the evidence is strongly in your favor -- that evidence based medicine could very well support a claim - because it is based on medical rationale -- i.e. evidence.

Like in my husband's case -- a doctor could SAY that his cancer might have started after the service - but medical evidence of cancer would probably show that would be very unlikely. They actually also have doctors who will testify. It looks like lawyers are starting to use these reports --

Anyway - it looked interesting -IF the evidence would be strongly in your favor.

http://www.nmrco.com/evidence.asp

What are the types of Evidence-Based Reports?

There are several types of Evidence-Based Reports.

Peer File Reviews (PFR) Following review of medical records and other information, an NMR specialist will provide a report based on the evidence from the history, physical findings and testing as well as on literature from the scientific community. The PFR will provide answers to questions such as validity of diagnosis, medical necessity of investigations and treatment, need for surgery, impairments or disability.

Evidence-Based Independent Medical Examinations (EBIME) NMR provides IMEs throughout North America by Practicing Board Certified Physicians of all specialties. NMR’s specialists offer expert evaluations of a full spectrum of medical conditions such as cardiovascular, endocrine, pulmonary, orthopedic, neurologic and psychiatric diagnoses. NMR’s IME services:

Determine appropriate type of specialist needed

Select specialist in vicinity of examinee

Schedule appointments

Communicate with client, examinee and specialist

Provide directions to physician’s office

Resolve problems - reschedule, etc.

Provide quality assurance of reports

NMR’s Quality Assurance program will ensure that the IME report will:

Be clear, understandable and defensible

Answer your questions

IMEs are used by the insurance, managed care and legal industries to determine:

Validity of diagnoses

Causation of medical conditions

Medical necessity of:

- Testing

- Treatment

- Hospitalization

- Surgery

Maximum medical improvement

Restrictions and limitations

Impairment or disability

Reasonableness of coding and fees

Answers to other health-related issues

Evidence-Based Medical Report

Evidence-based evaluation by a Board Certified Specialist with medical literature references to support the validity of diagnoses, severity of diagnoses, impairments, limitations and restrictions, and retained functional abilities. The claimant may have multiple diagnoses or conditions to be evaluated. The medical decision-making may be complex and the report provides a thorough explanation of the evidence that indicates the claimant's level of function. For Worker's Compensation cases, the report also includes a review and evaluation of medical care/treatment.

Comprehensive Peer Assessment (CPA)

Evidence-based assessment by a Board Certified Specialist, who will perform a thorough evaluation of the claimant's information. The Specialist will determine if there is adequate information in the medical records to accept or reject the opinion of the treating physician who has endorsed disability. If there is insufficient information, the Specialist will perform a teleconference and indicate to the treating physician any additional testing, specialty consultations, FCE, etc., which are needed to support work loss. The Specialist will also clarify plan language, internal evaluations, guidelines, etc., with referring company. Medical literature references will support the Specialist's assessment of functionality. The assessment will provide evidence for assurance that it is a valid claim for payment, or it will provide defensible evidence for a claim denial. For more info: www.nmrco.com/cpad.pdf